RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX  	CASE:  PD-2017-03026
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aviation Mechanic, medically separated for “anxiety disorder” and “left shoulder pain,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  Review of all conditions requested.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (MEB), but determined by the PEB to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions; that role and authority is granted by Congress to the Department of Veterans Affairs, which operates under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20090513	VARD - 20100104	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Generalized Anxiety Disorder	9400	10%	PTSD (Also Claimed as Generalized Anxiety Disorder)	9411	50%	20091102	
Chronic Left (Non-Dominant) Shoulder Pain	5099-5003	10%	Left Shoulder Tear of the Anterior Superior Glenoid Labrum	5299-5203	10%	20091008	
GERD	Not Unfitting	GERD	7399-7346	10%	20091008	
Eczema	Not Unfitting	Any Skin Condition	7806	Deferred	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Generalized Anxiety Disorder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s anxiety condition began in 2007 after returning from Iraq.  His symptoms included sleep difficulty, anxiety, irritability and depressed mood.  

During a November 2007 pulmonary clinic examination, the CI stated he had nightmares that were vivid and realistic.  In the nightmares, his teeth were falling out while talking with someone and then suddenly he fell over dead.  The CI noted he had no history of exposure to any significant trauma while in Iraq and believed Iraq was not related to his current sleep problem.  

At the 4 February 2009 MEB NARSUM examination, 7 months prior to separation, the examiner noted the CI had diagnosis of depression and post-traumatic stress disorder (PTSD) and was receiving treatment but a psychiatric MEB was not planned.  Therefore, the CI met retention criteria, but he was also referred for psychiatric evaluation.  

During the 6 April 2009 psychiatry addendum to the MEB NARSUM examination, 5 months prior to separation, the CI complained, “I think sleep is the biggest thing, If I could sleep I’d be better.”  The CI also noted irritability, and depressed mood that improved somewhat with medication.  He reported that during November 2005 to November 2006 deployment he did not go outside the wire, but he was frightened by events.  Though he was an avionics communication repair specialist, every time he was on guard duty, he thought he was going to get shot.  He was troubled by witnessing two body bags and injured soldiers returning to the forward operating base.   The CI stated he averaged only 4-6 hours of sleep per night.  

A mental status examination (MSE) was unremarkable with the exception of mildly irritable mood and restricted affect.  The examiner opined that the CI’s anxiety symptoms related to combat were mild with the exception of irritability and insomnia.  However, the examiner noted that the anxiety symptoms with some features of depression did not appear to be directly related to combat stress, but rather to generalized anxiety.  The examiner documented treatment for depression and PTSD but treatment records addressing those conditions were not present, nor was evidence of specific stressor.  The CI reportedly acknowledged that his anxiety began when starting military service, with exacerbation progressing throughout deployment.  

At the 2 November 2009 VA Compensation and Pension (C&P) mental examination, 2 months after separation, the CI reported feeling overwhelmed, anxious, edgy and panic symptoms in the context of war-related memories.  He reported daily nightmares and trouble sleeping, as well as other symptoms suggestive of PTSD.  The CI was looking for a job and taking care of his dogs.  He worked around the house, and for fun he enjoyed sporting events, bowling, watching TV, and engaging in activities with his friends.  He dated but did not have a girlfriend.  The MSE was unremarkable.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the mental health condition 10%, coded 9400 (generalized anxiety disorder), citing criteria for a 10% rating based on mild or transient symptoms of anxiety, depressed mood and chronic sleep impairment, which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. The VA rated 50% for PTSD, coded 9411, based on the C&P examination, citing occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks, more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.  

The panel members first agreed that the provisions of VASRD§ 4.129 for a “mental disorder that develops in service as a result of a highly stressful event” were not applicable.  During the November 2007 pulmonary examination, the CI reported he was not exposed to any significant trauma while in Iraq.  The STR also indicated there was no specific traumatic event during service.  

The panel next proceeded with the rating recommendation.  The panel considered the absence of emergency room treatment, or hospitalization, and the apparent stability of symptoms during the 2 years prior to separation.  The NARSUM examination noted that occupational and social impairment was due to transient symptoms that worsened with stress.  The C&P examination showed that the CI’s condition was stable and mild.   He was seeking employment and had an active social life.  There were no reports of chronic sleep impairment, problems with memory, or panic attacks interfering with duty performance.  The panel also noted the absence of a MH profile prior to the MEB psychiatric addendum.  There was no mention of any MH issues, or problems with performing duty tasks as the result of irritability, inability to focus or concentrate, difficulty getting along with others, falling asleep on the job, or inappropriate behaviors.  

Panel members agreed the 10% rating and no higher was justified for “occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the generalized anxiety disorder.  

Chronic Left (Non-Dominant) Shoulder Pain.  According to the STR and MEB NARSUM, the CI’s left shoulder condition began in September 2007 when his shoulder suddenly buckled and gave out after lifting a Blackhawk helicopter blade. A 1 February 2008 MRI arthrogram showed a small anterior glenoid labral tear.  Surgery was not recommended.  

During the MEB examination 7 months prior to separation, the CI reported chronic left shoulder pain. Physical examination revealed tenderness in the anterior deltoid region and normal motor strength and sensory function.  Goniometer-measured range of motion (ROM) was abduction at 140 degrees (normal 180), and flexion to 120 degrees (normal 180).  The same-day MEB NARSUM examination noted complaints of left shoulder pain and inability to pass the fitness test, perform any type of overhead reaching or work, or ruck.  There was no history of dislocation.  Physical examination was recorded on the DD 2808 above.  

At the 8 October 2009 C&P examination, one month after separation, the CI reported increased shoulder pain during cold weather, and pain daily with use, accompanied by weakness, instability or giving way.  Physical examination showed tenderness about the shoulder joint, no evidence of inflammation, or instability, and no guarding of movement.  Painful motion was present.  There was full active flexion and abduction ROM.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 10%, analogously coded 5003 (degenerative arthritis), citing consideration of functional loss IAW VASRD §§4.10, 4.40. 4.45, and 4.59.  The VA also rated the left shoulder condition 10%, analogously coded 5203 (clavicle or scapula, impairment), based on the C&P examination, citing painful motion.  The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level.  Although there was no limitation of motion to support a rating under the 5201 code, panel members agreed that a 10% rating was justified with application of VASRD §4.59 and 4.40 (painful motion, functional loss).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code  and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the chronic left shoulder pain.  

Contended PEB Conditions:  GERD and Eczema.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Neither of the conditions were profiled or implicated in the commander’s statement, and they did not fail retention standards.  There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the generalized anxiety disorder and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  In the matter of the chronic left shoulder condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  
In the matter of the contended GERD and eczema conditions, the panel recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:  

PD-2017-03026

[AR NUMBER], XXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

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Enclosure

	

PD-2017-03026